Nutrition smoothing: Can access to towns and cities protect children against poor health conditions at birth?

Seasonal fluctuations in early life circumstances can be associated with later differences in health outcomes. Other evidence finds that access to markets and services can help rural households improve their well-being. This study links these two phenomena, using spatial diversity across the Democratic Republic of Congo (DRC) to investigate whether proximity to towns confers resilience against seasonal determinants of health. To identify a potentially causal effect, we use the random component of birth timing relative to the intensity of seasonal climate fluctuations and households’ distance to the nearest town. We find that that children in households closer to towns have significantly smaller impact of their birth timing on their subsequent heights and risk of death. The protective effect of towns could involve a variety of mechanisms such as consumption smoothing, disease cycles, health services and public assistance. Future work might find ways to distinguish among these channels using additional data.